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Medicare at 50: Next?

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Here’s an important review and look ahead for Medicare on its 50th birthday in The New England Journal of Medicine:

It looks at:

Rising spending.

Quality improvement.

Program fragmentation.

Coverage gaps.

Proposals to improve Medicare, including provider-payment reform (especially moving to fee for quality and value from fee for service) and organizational reform.

The article notes:

”Despite its intuitive appeal, value-based purchasing faces a number of challenges. It depends on the development of effective, and preferably outcome-based, measures. …{C}ritics point out that value-based purchasing should more effectively utilize the power of nonfinancial incentives, such as professionalism and organizational culture, in motivating clinician behavior and improving performance.”

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